There is a reasonably well-established dogma in the ED that giving glucose before thiamine (Pabrinex) to alcoholics can precipitate severe and permanent Wernicke’s encephalopathy. The physiological idea behind it is this: an excessive carbohydrate load leads to the build up of toxic metabolites in the thiamine-deficient brain, because thiamine is a co-factor for several essential enzymes in the Krebs cycle. But is there any evidence for this?

 

Journal of Emergency Medicine, April 2012